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General NPI Number Information
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NPI Number | 1871833293
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Entity Type | Organization
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Legal Business Name | DR. SUSAN PORIES
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Dates
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Enumeration Date | 02/21/2013
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Last Update Date | 02/21/2013
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Provider Practice Location Address
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Address Line | 300 MOUNT AUBURN ST DOB 509
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City | CAMBRIDGE
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State | MA
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Zip | 02138-5600
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Country | US
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Telephone | 617-576-3350
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Fax | 617-576-6422
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Provider Business Mailing Address
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Address Line | 300 MOUNT AUBURN ST DOB 509
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City | CAMBRIDGE
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State | MA
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Zip | 02138-5600
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Country | US
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Telephone | 617-576-3350
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Fax | 617-576-6422
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. SUSAN E PORIES
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Credential | MD
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Telephone | 617-576-3350
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | 71236
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License Number State | MA
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